ADT + Docetaxel

[Ian99]

Am mCRPC and will be starting Docetaxel soon, after apparent failure of Zytiga. Would like to know if I should continue the ADT (zoladex), which I have tolerated well for 3 years.

Most trial info I have found (STAMPEDE, CHAARTED) tests ADT alone vs ADT + Docetaxel, where the combination outcome is superior.

Is there any info on Docetaxel alone vs Docetaxel + ADT; or what is generally recommended? Thanks.

[Big_Mcc]

Hi Ian. I was given ADT + Docetaxel, 6 rounds each one 3 weeks apart. ADT continues for LIFE. I asked what's next, my Onc said enzalutamide and when that fails another 6 rounds of Docetaxel. That's the end of the line. Im hoping by then there will be another treatment available to me. I found the Docetaxel infusions were manageable but the long term effects were devastating. My hair grew back and darker than when it fell out but my skin aged 50 yrs lol. Went from a smooth flexible skin to a dry and very wrinkly thin skin. My body pains and aches increased considerably. Would I do it again? Yes but only because the alternative is an earlier death. Life is too precious to miss even a second. I hope it will all go well for you brother.

[Ian99 in reply to Big_Mcc]

Thanks for that. When I asked what next, I was told Cabazitaxel.. did your MO not mention it ? Further on I am counting on Pluvicto or some variation thereof, if PET scan results permit. Unlikely to be sanctioned in this country but readily available abroad. So don’t give up, mate!

[Big_Mcc in reply to Ian99]

Not giving up but I am in the UK and that is what is available here under SoC. Ofc I can have anything I desire if I can pay for it privately lol. Most of us can not. Good luck and long life brother.

[God_Loves_Me in reply to Big_Mcc]

The only thing I would ask your MO is, What about Docetaxel resistence? I was reading that once you have docetaxel then cancer cells become resistant to docetaxel in future

if you help me to get this answer, It help me in my treatment plan as well.

[Fisherman2 in reply to Big_Mcc]

Cabazitaxel was approved for use in UK in 2016. It is normally given when docdtaxel fails.

[Ian99 in reply to Fisherman2]

Yes, but I think Mcc is up in Scotland. Some differences up there.

[God_Loves_Me]

In USA, There is concept call "triplet therapy" that inlude ADT + Docetaxel + Nubeqa or Xtandi (both are from same class). It is one of the best results after treatment and great quality of life as well.

I also read from many users that they stay on ADT for life and start Nubeqa or Xtandi before 2 or 3 month before of first chemo infusion to avoid side effects.

[Ian99 in reply to God_Loves_Me]

Thanks. I have had the impression triplet therapy is usually for hormone sensitive.

Re SEs, I have a list of things to mitigate (cold socks, mitts, fasting). Was unaware Xtandi could also mitigate. But not SOC here.

[God_Loves_Me in reply to Ian99]

Here is the source of informations :

prostatecancer.news/2021/05...

prostatecancer.news/2022/10...

[dhccpa in reply to God_Loves_Me]

Yes, I believe triplet therapy is for newly diagnosed metastatic patients, whereas he is now resistant.

[Ian99 in reply to God_Loves_Me]

I really like the idea of moving to Xtandi now, as you say, before starting on Docetaxel. I was even unaware of the SE mitigation. Per the PRESIDE trial, Docetaxel could also have the effect of prolonging Xtandi effectiveness. But my MO says there is cross resistance in moving from Zytiga to Xtandi. Tbh I find the views from the medical community vary on this topic.

[God_Loves_Me in reply to Ian99]

Yes your MO is correct. Xtandi doesn't work because of cross resistance still you do not need worry about side effect during infusion time. I wish if there is better way to fix with cross resistance without chemo.